| NPI | 1619156551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 104) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 056677) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A135925) | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2017-11-30 |